The Bush thugs had an agenda to go to war; any facts were immaterial and all of it was based on another lie (first lie was the election). American soliders are giving their lives–for what?–for a lie! Shame on you for even considering that a few words would make all of this right.

JEAN MILLER Irvine, CA

Dear Jean,

In the first place, let me begin by agreeing with you that the 2000 election result was a lie.

Further, it is inconceivable to me that the current Democratic hopefuls are not reminding the American public right now of that fact. Whether or not it is expedient on the part of a candidate to refer to it, I agree that it is an unprecedented event that is a departure point for more and more lawless thuggery.

In David Corn’s terrific new book, the various lies of George W. Bush are laid out in compelling detail. And I am not someone to excuse any of this behavior or to see it as other than agenda-driven from the outset.

But if we are to counter it, or to provide better examples of human behavior, we must not resort to distortions or rhetoric ourselves. I was simply pointing out that a moral or ethically driven human being who is caught in a significant lie that undermines his or her integrity would begin by apologizing or being remorseful. I never said or implied that a response would excuse the behavior or let the person off the hook. To see that in my words is to distort them.

Rather, I would maintain that the lack of such a human response by Bush and his crew represent a further example of the manipulations that led us into this mess in the first place. Remorse would be automatic if the President really cared about what he was saying. If he was bringing America to war for what he believed were legitimate reasons but which have since been shown not to be the case–wouldn’t his first response be regret and remorse?

Near the end of Corn’s book, he examines the question of whether Bush knows the extent to which he lies. Corn acknowledges that this is a tough question to answer. He finds evidence that Bush is mendacious, and thinks of lying as part of politics. I also believe that there may be a “holier-than-Thou” aspect to Bush’s moralizing, almost as though we the pawns and the peons aren’t entitled to know the real truth. I find proof of his lack of sincerity in his staged emotions. And one of his coaches forgot to include regret in his list of simulated human responses. Luckily for us, this omission is a glaring one. We shouldn’t overlook the error by finding it tiny in comparison to his crushing worldwide agenda. Nor should we resort to rhetoric or distortions ourselves.

Why is it that in the United States our drug prices are higher than any other nation? The drug companies claim we are paying for research and development but in reality almost all R&D is done in government labs that are funded by tax dollars. That must mean we are double paying for the R&D. Is this true? And, if so, why is this fact not brought up in the media?

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It is true and I couldn’t agree with you more. In fact, I just addressed this topic in a letter to the New York Times this week in response to an under-informed column by William Safire. In part, I said: “We should not assume that the cost of research and development is the engine that drives price inflation. Many medications in a given class are duplicates of each other, and millions of dollars of drug research money are spent creating new competing chemicals only slightly different from already effective medication It’s amazing the ritualistic, sacrosanct mantra that R&D has over certain thinkers.” Also check out my Nationarticle from June 17, 2002, which details drug company excesses.

As far as I know, Dennis Kucinich and Carol Moseley-Braun are the only Democratic presidential candidates with single-payer health insurance as a platform plank. Several others, including Dean, have offered various systems of subsidies to cover more people in a privatized system. Dean actually acknowledged in an interview with RadioNation’s Marc Cooper that single-payer is a better, less expensive system, but he claims that it can’t be passed with this Congress, and that he’s just being pragmatic. The Clintons’ plan was obviously deeply compromised, and in fact authored in part by the insurance industry, and it didn’t get passed either. My feeling is, why not go for broke with single-payer?

MATT CORSARO New Paltz, NY

Dear Matt,

Of course candidates should speak to the issues, and compromise for the sake of political expediency always rings hollow, and is rampantly pervasive. I’m not sure what Dr. Dean believes, and he has certainly equivocated on healthcare. At the same time, I believe that our current healthcare system is so permeated by private interests (a trend that will be growing thanks to the new Medicare bill) that large-scale reform to single payer simply has no chance currently. This is tragic, and our system will fall a lot farther down before any major reform–like Medicare in the 1960s–is instituted.

I’m pretty sure my mother is going to see her drug costs increase as a result of the Medicare bill. She’s certainly not wealthy but she’s lucky to be a long way from poverty. She receives a good monthly pension from TIAA-CREF via my deceased father that is almost twice what she earned while working. But as her health declined she fell to the mercy of the health care system and it soon became insufficient.

How do you read this bill? And if one of the thresholds for the poorest to qualify is 150 percent below poverty, and if there is an asset test…well, you know the rhetoric.

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I have some articles due to be published on this topic, including one in The Nation in a few weeks, so I’ll hold off on a complete reply. But in terms of drug coverage, consider this: the so-called coverage will require $4,800 out of pocket for the first $1,000 of coverage that you receive, all at top-dollar prices. This will lead to unfair comparisons between traditional Medicare, and the HMOs who enter the game and will be allowed to negotiate for lower drug prices. They’ve got us by the proverbial you-know-what. Your mother, if she joins one of those plans, will probably see her services gradually reduced in order to ensure the HMO profits, as occurred in the nineties when HMOs first entered the Medicare arena. For a fine perspective piece on this wretched plan, take a look at Trudy Lieberman’s “Killing Medicare,” in the December 15 issue of The Nation.

I am writing again because everyone forgot about the unfortunate Kaiser Dr. in Baldwin Park–and the nightmare at KP won’t go away. Here’s my take: Look at the two major strikes in Southern California, each in their fifth week. In both cases, workers are upset that they are being asked to shoulder (in the grocery store case) more of the cost of HMO premiums (with little or no raises to compensate); or (in the MTA mechanics case) any of the cost.

I am as pro-labor as anyone you ever met–and yet I can understand why these employees would be asked to contribute more. There have been double-digit increases in premium costs for years in California, including Kaiser who is (I believe) the largest insurer in the state.

The $2 billion wasted comes out to some $400 per member–you can’t convince me this isn’t a large part of the additional premiums being charged. Therefore, Kaiser’s failed IT projects have directly caused crippling strikes in the second largest city in the country. Now, the project they started in place of the $2 billion wasted is going down the same route, with waste and fraud abounding. It’s time to blow the whistle; in fact it’s way overdue.

DAVID BROWN San Francisco, CA

Dear David,

Interesting speculation. I would not be surprised to find out that waste and bureaucratic mismanagement permeates a place like Kaiser, which still parades under a banner of “non-profit.” It goes along with this corporate model that any funding problem or big- time loss immediately be passed along to the consumer in terms of increased premiums.

What can be done to substantially improve provider compliance with expert-established treatment protocols, increased use of ICU “intensivists,” and improve the proportion of care provided by “high-volume” practioners (essentially LeapFrog’s recommendations)?

From what I read, these efforts are impeded by physicians resisting freedom of practice and potential loss of income, and payors not seeing any financial reward in improvement.

LOYD ESKILDON Scottsdale, AZ

Dear Loyd,

High-volume practitioner and quality of care seems to be to be largely a contradiction in terms. However, your accompanying notion of increased use of experts, including ICU intensivists, makes sense to me, if not always in a cost-effective sense, at least in terms of improving the practice of empiric knowledge-based medicine.

Dr. Marc Siegel Dr. Marc Siegel is a practicing internist and an associate professor of
medicine and a fellow in the Master Scholars Society at New York
University School of Medicine. He is a weekly columnist for the New
York Daily News, a frequent contributor to the Los Angeles Times, the Washington Post and The Nation. He is a member of the board of contributors at USA Today. He appears frequently on CNN, the Fox News Channel, and the NBC Today Show. He is the author of False Alarm: the Truth About the Epidemic of Fear and most recently, Bird Flu: Everything You Need to Know about the Next Pandemic (Wiley).